Advances in hip arthroplasty surgery: what is justified?

Abstract

Total hip arthroplasty (THA) surgery has shown dramatic changes in terms of increased number of procedures and of technical development in recent years. It has been described as “the operation of the 20th century” for the excellent results, the high satisfaction of the patients and the improvement of the quality of life.A lot of variations have been introduced over the last few decades in THA especially in terms of indications (both in younger and older patients), techniques and devices (approaches, tissue preservation, biomaterials and industrial finishing), per-operative management (blood loss and pain control) and post-operative protocols (the so called “fast track” surgery). Looking at all these advances the emerging question is: have all of them been justified both in terms of improvement of the results for the patients and of the cost/benefit ratio from an economical point of view?The purpose of this paper is to critically analyse the advantages and the disadvantages of the theoretically proposed “advances in hip arthroplasty” and attempt to understand which are justified of such “advances” nowadays, based on the international and the European perspective with a focus on the author’s personal clinical experience.Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.170008. Originally published online at www.efortopenreviews.org

Current Preclinical Testing of New Hip Arthroplasty Technologies Does Not Reflect Real-World Loadings: Capturing Patient-Specific and Activity-Related Variation in Hip Contact Forces

“…The ever-improving survivorship of joint arthroplasties is evidence of the important continued innovation and improvement in implant design and surgical techniques, which has led to better implant fixation options, improved wear performance, and reduction in perioperative and postoperative complication rates [2,3]. The outcomes of novel implant design are not however always better than for existing implants [10,11].…”

Have the annual trends of total hip arthroplasty in rheumatoid arthritis patients decreased?

“…An aging population may mask the true efficacy of DMARD therapy, despite the breakthroughs in the medical management of RA. Alternatively, new advances in THA have significantly improved patient quality of life and satisfaction (28), while shorter hospital stays, improved pain control, and earlier achievement of rehabilitation goals have been accomplished with breakthroughs in anesthetic regimens and postoperative pain management (29)(30)(31). Considering all of these factors, the threshold for RA patients to opt for surgical management may, therefore, be lower than it was in the past.…”

Changes in expression of serum chemokine CXCL13 and IL-6 after hip replacement, and the relationship with lower limb vein thrombus

“…It is mainly applicable to some fractures (such as femoral neck fracture), osteoarthritis, bone neoplasms, ankylosis or hip dysplasia, and others. As one of the most effective methods for joint correction, hip replacement is mainly to relieve hip joint pain, correct deformity, restore and to improve hip joint movement function (1)(2)(3). It uses prostheses similar to human bone joints made of metal materials with good biocompatibility and mechanical properties to replace joint surfaces damaged by diseases or injuries through surgical methods (4)(5)(6).…”